LEGISLATIVE FISCAL ESTIMATE

ASSEMBLY, No. 6201

STATE OF NEW JERSEY

221st LEGISLATURE

 

DATED: DECEMBER 22, 2025

 

 

SUMMARY

 

Synopsis:

Amends Fiscal Year 2026 annual appropriations act to remove language requiring achievement of cost savings for SHBP.

Type of Impact:

Potential State expenditure increase.

Agencies Affected:

Department of the Treasury.

 

Office of Legislative Services Estimate

Fiscal Impact

 

Fiscal Year 2026 

 

 

Potential State Expenditure Increase

 

Up to $25 million

 

 

 

·         The Office of Legislative Services (OLS) determines that removing the language provisions in the FY2026 Appropriations Act that require the achievement of $100 million in cost savings in State funds appropriated for the State Health Benefits Program may result in a State expenditure increase of up to $25 million. 

 

BILL DESCRIPTION

 

      This bill amends the FY2026 Appropriations Act to remove language provisions requiring the achievement of cost savings in State funds appropriated for the State Health Benefits Program. 

      Currently, the FY2026 Appropriations Act contains language provisions requiring the State to achieve $100 million in actuarially verifiable cost savings through a series of submissions of cost saving proposals, legislative action, and negotiations.  This bill removes the language provisions requiring the achievement of and outlining the process for such cost savings.

 

 

FISCAL ANALYSIS

 

EXECUTIVE BRANCH

 

      On September 24, 2025, the State Health Benefits Program Plan Design Committees adopted four resolutions designed to achieve approximately $75 million in State health benefit cost savings in the final six months of FY2026 pursuant to an agreement between Governor Murphy and the public sector unions.

      The resolutions that are expected to generate such cost savings are as follows:

·         Resolution 2025-10: $110 in-network deductible for individuals and $220 in-network deductible for families for all plans that currently have lower deductibles; $750 out-of-network deductible for individuals and $1,500 out-of-network deductible for families for all plans that currently have lower deductibles; $2,500 out-of-network, out-of-pocket maximum for individuals and $6,000 out-of-network, out-of-pocket maximum for families for all plans that currently have lower out-of-network, out-of-pocket maximums; new co-pays on lab visits and imaging across all plans; limits on out-of-network physical therapy visits across all plans.

·         Resolution 2025-11: new co-pays on GLP-1, generic, brand, non-preferred brand, and specialty medications across all plans.

·         Resolution 2025-12: incentivizing use of in-network ambulatory surgical centers for certain procedures across all plans.

·         Resolution 2025-13: expansion of the forthcoming Centers of Excellence pilot program for all plans.

       

 

OFFICE OF LEGISLATIVE SERVICES

 

      The OLS determines that removing the language provisions in the FY2026 Appropriations Act that require the achievement of $100 million in cost savings in State funds appropriated for the State Health Benefits Program may result in a State expenditure increase of up to $25 million. 

      Currently, the FY2026 Appropriations Act contains language provisions requiring the State to achieve $100 million in actuarially verifiable cost savings for the State Health Benefits Program.  By removing this language, the State is no longer required to achieve the full $100 million in cost savings. 

      However, according to the Governor’s Office, the resolutions adopted by the State Health Benefits Plan Design Committees on September 24, 2025 are estimated to achieve approximately $75 million in recurring health benefit savings in the final six months of FY 2026, leaving $25 million of the initially required $100 million in cost savings not achieved, assuming the savings from the plan design resolutions are realized. 

 

Section:

State Government

Analyst:

Camryn Mathews

Associate Fiscal Analyst

Approved:

Thomas Koenig

Legislative Budget and Finance Officer

 

This legislative fiscal estimate has been produced by the Office of Legislative Services due to the failure of the Executive Branch to respond to our request for a fiscal note.

 

This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).